AMA Members: Focus on Regulations, Not Legislation

Congress won't pass many bills in a presidential election year

WASHINGTON -- Physicians' strategy for lobbying Congress this year should focus on influencing the wording of regulations, not on getting laws enacted, a member of Congress said at the American Medical Association's (AMA) annual advocacy meeting.

"If I were you, one thing I'd be doing is not worrying about big legislation passing Congress," Rep. Xavier Becerra (D-Calif.) told the AMA members assembled at a hotel here. Instead, "I'd be getting to know Andy [Slavitt, administrator of the Centers for Medicare and Medicaid Services (CMS)] very, very well," especially since Slavitt's agency will be busy implementing the new physician payment system that will replace the much-maligned sustainable growth rate (SGR) formula.

Because it's a presidential election year, "It's not going to be a year where we [in Congress] try to throw long passes and score big touchdowns; it's going to be a year where we try to get the things done that need to be done and don't interfere with the presidential election process," he said.

One issue that Congress is considering at the moment is prescription drug pricing, Becerra added. "Physicians are on tight [payment] schedules and hospitals are restricted in what they can charge [but] drugs are still the wild, wild West. I urge you to consider what ways AMA would like to weigh in on prescription drugs."

Another issue Congress may make progress on is encouraging the use of telehealth. Sen. Brian Schatz (D-Hawaii) talked about a bill he is sponsoring, S.B. 2484, also known as the CONNECT for Health Act (CONNECT stands for Creating Opportunities Now for Necessary and Effective Care Technologies).

The bill, which has been endorsed by the AMA, would allow telemedicine and remote patient monitoring to be used by providers who participate in alternative payment models such as accountable care organizations. It also would permit the use of telehealth in rural health clinics and community clinics and also, under certain circumstances, in dialysis facilities; and it would allow telehealth and remote patient monitoring to be basic benefits in Medicare Advantage programs.

"The Congressional Budget Office has previously called telehealth expensive ... However, we have now seen many, many studies on telehealth and remote patient monitoring that show significant cost savings," Schatz said. "We have structured the bill in a way that would lift the restrictions [on the technology] but would save Medicare money."

Slavitt also spoke to the assembled physicians, telling them that although new medical technologies like "wearables and shareables" have promise, "we can't devalue the most important and precious element of healthcare: the time the patient has with their physician."

"We believe we need to move back to a place where doctors talk to patients about their health, not just paying for technology, devices, surgeries, and prescriptions," he said to applause from the audience.

"We must be more flexible to the needs of physician practices," Slavitt continued. He listed several provider-friendly moves his agency made to help doctors transition to the ICD-10 coding system, including adjustments to reduce "needless" penalties, installing an ICD-10 ombudsman, setting up a fulltime command center, and committing to a 3-day turnaround for questions and concerns.

"It's about being publicly transparent and metric-driven," Slavitt said. "We've embraced this approach also as we've implemented new payment models. Our newly launched Next Generation ACO model is a good example -- it includes innovative options like telemedicine, home visits, and direct patient incentive and engagement options. We are also soliciting an unprecedented amount of physician input as we implement the [Merit-based Incentive Payment System]."

In a briefing with reporters, AMA president Steven Stack, MD, agreed that Slavitt had been "very responsive" to physician concerns. "He is concerned that CMS has lost physicians and there's a need to listen to doctors more closely," Stack said. "He has demonstrated not just through words but through actions that he's willing to work with us."

The AMA will continue to focus on improving the Meaningful Use program for electronic health records (EHRs), Stack added. "Meaningful Use needs to be less prescriptive."

One thing that should help, he said, is CMS's new requirement for the use of application program interfaces that will allow EHRs from different facilities to communicate with one another. That will enable people who have already bought expensive EHRs to keep them, "but [also allow] for a new layer of competitive marketplace to arise, where other vendors ... will be able to create much more finely tailored applications for much smaller user groups."

Addressing the opioid abuse epidemic is another priority for the AMA, Stack said, noting that the price of a single dose of naloxone, the overdose treatment drug, rose from $4.50 in 2010 to $38.00 in 2015 in his hometown of Lexington, Ky. "This is not the time for pharmaceutical industry to play games in an epidemic that's taken [thousands of] lives," he said. "We should ensure it's as cheap as water from the tap. Hopefully they can see their way to doing the right thing."

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